Cognitive Behavioral Therapy for Perinatal Insomnia: Exploring Adherence, Perceived Usefulness of Intervention Components, and their Associations with Sleep Outcomes

Abstract

Objective: To explore the adherence and perceived usefulness of Cognitive Behavioral Therapy for Insomnia (CBT-I) components in the perinatal period and their association with sleep outcomes. Methods: Seventy-six nulliparous individuals (age M = 33.07 SD ±3.10) from two randomized control trials who received CBT-I at three time points: late pregnancy (35 weeks’ gestation), 1.5–3 months postpartum, and 6 months postpartum were analyzed. At each time point, participants self-reported perceived usefulness and adherence for each of the six CBT-I components, and completed the Insomnia Severity Index (ISI), PROMIS Sleep-Related Impairment (PROMIS-SRI), and Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16). Results: All components were perceived as useful by most (74.3–97.1%) participants; adherence varied between components and across time. Cross-sectional multiple regression analyses showed that for “sleep hygiene”, higher adherence was associated with lower DBAS-16 at 35 weeks’ gestation (small effect). Higher adherence and usefulness to “managing sleep deprivation, sleepiness and fatigue” was associated with lower ISI at 6 months postpartum (small and medium effect size, respectively); higher perceived usefulness was associated with lower PROMIS-SRI at 6 months (small effect; all p-values